Regular handwashing is an important step in minimizing the spread of germs. Hands pick up germs from all of the things they touch and then spread them from one place to another. Germs that are on hands can also enter the body when a person eats or when they touch their eyes, nose, mouth, or any area on the body where the skin is broken (because of a cut, rash, etc.).
All that is needed for handwashing is soap and clean, running water. Handwashing with soap and water removes visible dirt and hidden germs. Studies have demonstrated that handwashing reduced the number of diarrheal illnesses by 31 percent and respiratory illnesses by 21 percent.
The Centers for Disease Control recommends the following handwashing steps:
“Wet your hands with clean, running water (warm or cold) and apply soap.”
“Rub your hands together to make a lather and scrub your hands well; be sure to scrub the backs of your hands, between your fingers, and under your nails.”
“Continue rubbing your hands for at least 20 seconds. Need a timer? Hum the “Happy Birthday” song from beginning to end twice.”
“Rinse your hands well under running water.”
“Dry your hands using a clean towel or air dry them.”
Figure 10.2.1 – Illustrations of the 5 steps of handwashing.374
Infants and young children will need help with handwashing. Caring for Our Children recommends that caregivers:
Safely cradle an infant in one arm to wash their hands at a sink.
Provide assistance with handwashing for young children who cannot yet wash their hands independently.
Offer a stepping stool to young children so they may safely reach the sink.375
Diaper Changing
Diaper changing areas should be smooth and nonporous (such as a plastic-covered pad), have a raised edge to prevent children from falling, be near a sink, be out of reach from children, and be away from food preparation areas.386
The following diaper-changing procedure should be posted in the changing area and followed to protect the health and safety of children and staff:
Step 1: Before bringing the child to the diaper changing area, perform hand hygiene (including putting on gloves, if using), bring supplies to the diaper changing area, and place a disposable liner on the changing area.
Step 2: Carry/bring the child to the changing table/surface, keeping soiled clothing away from you and any surfaces you cannot easily clean and sanitize after the change. Always keep a hand on the child.
Step 3: Remove the soiled diaper and clothing without contaminating any surface not already in contact with stool or urine. Put soiled diapers in a covered waste container. Put any soiled clothing in a plastic bag that is securely closed to give to the family.
Step 4: Clean the child's diaper area with disposable wipes and place soiled wipes into a covered waste container.
Step 5: Removed the disposable liner and gloves and place them in a waste container
Step 6: Use facial tissue to apply any creams or ointments. Slide a clean diaper under the child, fasten it, and dress the child.
Step 6: Wash the child's hands and return the child to a supervised area.
Step 7: Clean and disinfect the diaper-changing surface and any equipment or supplies that were touched (and any other area the child soiled before changed).
Step 8: Perform hand hygiene and record the diaper change, diaper contents, and/or any problems.
Caregivers/teachers should never leave a child unattended on a table or countertop. A safety strap or harness should not be used on the diaper changing table/surface.387
If Using Potty Chairs
Due to being hard to clean and disinfect, potty chairs are not ideal in a childcare environment. If they are used, they should be used in the bathroom only. After each use:
Empty contents immediately into the toilet
Rinse with water and dump water into the toilet
Wash with soap and water (with a paper towel) and empty soapy water into the toilet
Rinse again and empty into the toilet
Spray with bleach solution
Air dry
Wash and disinfect sink
Wash hands (child and adult)388
Toilet Learning
Toilet learning typically occurs between ages 2-3, but this can vary as children need to be developmentally ready in the cognitive, social, emotional, physical, and language domains first. Therefore, it is not unusual for children older than 3 years to still wear diapers or pull-ups. When a child is ready to engage in the toilet learning process, it is essential that professionals and families work together to determine the best timing and method. It can be helpful to put these plans into writing and have it translated to a family's home language if necessary.
Never rush, shame, punish, or tease children during the learning process. Instead, be encouraging. As children demonstrate signs of readiness and a desire to use the toilet, be supportive. With toddlers, accidents are going to happen- you can help children recover from these accidents by remaining calm and respectful. Accidents are common and will become less frequent as children get older. With preschoolers, make sure children feel comfortable going to the bathroom whenever they need to (Council for Professional Recognition, 2023).
Pause to Reflect
You are at a job interview to become a teacher in an infant room and the director asks you what you would do to prevent the spread of illness in your classroom. What might you want to mention?
Dental Hygiene
Dental hygiene is important to prevent early childhood caries (ECC), which is a term used to describe tooth decay, including filled or extracted teeth due to decay, in the primary teeth (baby teeth). It is important to rethink the way we “treat” dental caries. Traditionally, we would wait until a child had a cavity and “treat” the cavity with a filling. In order to prevent ECC, we must intervene before the first cavity develops.317 Early care and education programs can teach children and families about dental hygiene and oral care as well as implement good dental hygiene practices. Here are some ideas:
Use teaching practices that engage children and promote thinking critically. Consider asking questions such as:
How do you brush your teeth?
Why do you brush your teeth?
What else can you do to keep your mouth and teeth healthy?
What happens if you don’t brush your teeth?
Tell me about your last visit to the dentist.
Integrate oral health into activities (in addition to tooth brushing). Some possibilities include:
Have children separate pictures of foods that are good for oral health from pictures of foods that are high in sugar.
Reading books with positive oral health messages to children.
Having children pretend they are visiting a dental office.
Singing songs about oral health
Engage families in promoting oral health at home. Some ways to do this include:
Working with families to find the best ways to position their child for tooth brushing. Remind families that young children cannot brush their teeth well until age 7 to 8. It is also important for a parent to brush their child’s teeth or help them with brushing.
Asking families to take photographs of their child brushing his teeth and helping the child write stories about his experience.
Helping families choose and prepare foods that promote good oral health.
Encouraging families to ask their child what she learned about oral health in school that day.
Offering families suggestions for at-home activities that support what children are learning about oral health at school.318
Classroom Tooth Brushing Steps
Sitting at a table in a circle, children brush teeth as a group activity every day.
Give each child a small paper cup, a paper towel, and a soft-bristled, child-sized toothbrush.
Put a small (pea-sized) dab of fluoride toothpaste on the inside rim of each cup, and have children use their toothbrushes to pick up the dabs of toothpaste.
Brush together for two minutes, using an egg timer or a song that lasts for about two minutes.
Brush your teeth with the children to set an example, and remind them to brush all of their teeth, on all sides.
When the two minutes are up, have the children spit any extra toothpaste into their cups, wipe their mouths, and throw the cups and paper towels away.
Children can go to the sink in groups to rinse their toothbrushes and put the toothbrushes in holders to dry.319
Figure 10.2.2 – Group tooth brushing in early care andeducation.320
Sleep Hygiene
It's important to get enough sleep. Sleep supports mind and body health. Getting enough sleep isn’t only about total hours of sleep. It’s also important to get good quality sleep on a regular schedule to feel rested upon waking.
Sleep is an important part of life! Young children spend around half of their time asleep.321
Babies need to sleep between 12 and 16 hours a day (including naps).
Toddlers need to sleep between 11 and 14 hours a day (including naps).
Preschoolers need to sleep between 10 and 13 hours a day (including naps).
School-aged children need 9 to 12 hours of sleep each night.322
We know how busy they are when they are awake, but what are they doing during all of those restful hours? Actually, sleep has many purposes.
Growth: Growth hormone is released when children sleep (Berk 2002, 302). Young children are growing in their sleep, and since they have a lot of growing to do, they need all the sleep they can get.
Restoration: Some sleep researchers have found that sleep is important for letting the brain relax and restore some of the hormones and nutrients it needs (Jenni & O’Conner 1995, 205).
Memory: Sleep is also a time when the brain is figuring out what experiences from the day are important to remember (Jenni & O’Conner 1995, 205).
Health: One study found that infants and toddlers need at least 12 hours of sleep in a 24-hour day. When infants and toddlers had less than 12 hours they were more likely to be obese by the age of 3 (Taveras et. al. 2008, 305).323
The Culture of Sleep and Child Care
Across the world, people sleep in different ways. Some people sleep inside, some sleep outside. Some people sleep in beds, others in hammocks or on mats on the floor. Some people sleep alone, some sleep with a spouse or children or both. Some people sleep only at night, while others value a nap during the day. How, when, and where people choose to sleep has a lot to do with their culture, traditions, and customs. This can include where they live, how their family sleeps, and even how many bedrooms are in their home. Teachers have a role in providing a sleep environment that is comfortable and safe for the children in their care while honoring families’ cultural beliefs.
What can teachers do to help young children feel more “at home” when it is time for them to rest?
Think of sleep and sleep routines as part of the child’s individualized curriculum.
Classroom teachers should meet with a family before a child enters your care. This is an opportunity to find out about a child’s sleep habits before they join the classroom. When you know how a baby sleeps at home, you can use that information to plan for how they might sleep best in your care.
Brainstorm ways to adapt your classroom to help a child feel “at home” during rest times. For example, a baby who is used to sleeping in a busy environment might nap better if you roll a crib into the classroom. Some mobile infants and toddlers might have a hard time sleeping in childcare because they think they will miss something fun! These children benefit from having a very quiet place to fall asleep. When you have a positive relationship with a baby it will be easier to know what will help them relax into sleep.
Encourage families to bring in “a little bit of home” to the program – like a stuffed animal or special blanket. A comfort item from home can help children feel connected to their families. They might want that comfort all day. The comfort item from home can also help children make the transition to sleep while in your care. Make sure that infants under one year of age do not have any extra toys or blankets in the crib with them.
Share with families what you learn about their child. Use pick-up and drop-off times to ask questions about sleep at home. Families can share information that could make their child more comfortable in your care. You can be a resource for families about sleep and their child. Remember that families are the experts on their children.
Napping and Individual Differences
Have you noticed that some children will fall asleep every day at the same time no matter what else is going on? These kids could fall asleep on their lunch if it is served too late! Have you known children who seem to fall asleep easily some days and other times just can’t settle into sleep? These children might need a very stable routine. Some toddlers nap less and sleep more at night while others need to have a long sleep during the day.
Temperament and Sleep
Some of the different patterns in children’s sleep has to do with their temperament (Jenni & O’Connor 2005, p. 204). Temperament is like the personality we are born with. Some children are naturally easy-going and adapt to new situations while others really need a routine that is the same every day. One child might fall asleep easily just by putting her in her crib or cot when she is drifting off to sleep. Another child might fall asleep in your arms but startle awake the moment he realizes he has been laid down alone.
Circadian Rhythms and Sleep
Something else that can make nap time easy or difficult for young children has to do with their natural sleep cycles. Everyone has a kind of “clock” inside of their bodies that tells them when they are hungry or sleepy. The cycle of this clock is called circadian rhythms. Circadian rhythms are the patterns of sleeping, waking, eating, body temperature, and even hormone releases in your body over a twenty-four-hour period. How much children need to sleep, when they feel tired, and how easily they can fall asleep are all related to their circadian rhythms (Ferber, 2006, p. 31).
Meeting Each Individual Child’s Sleep Needs
Thinking about the circadian rhythms and temperament reminds us how each child is different. That is why it is important to have nap times that meet the needs of all children in your care. Helping young children to learn to recognize their bodies’ needs and find ways to meet those needs is a very important skill of self-regulation.324
Figure 7.6 – Children may get tired at times other than nap/rest time.325
Individualizing Nap Schedules
Creating a space for sleepy children can allow them to relax or nap when their body tells them they are tired. It can take some creativity to figure out how to let a young child nap or rest when they are tired.
What do you do if a child won’t nap when others are? How does one child rest quietly in a busy classroom?
Two-and-a-half-year-old Henry is new to your classroom. His mother has shared with you that he does not nap during the day with her. When nap time comes around you can tell that Henry does not seem very tired.
What can you do for Henry, or other children like him, while the rest of the class sleeps?
Do you have a “cozy corner” that could also be a one- child nap area?
Are there soft places to sit and relax with a book or stuffed animal?
Are books or other quiet activities provided if a child isn’t able to rest or settle when other children are?
Are children provided techniques and strategies for calming their bodies e.g. deep breathing, tensing and relaxing their bodies, feeling their heartbeat, etc?326
Engaging Families
Professionals can use the following strategies to help families to develop their children’s health habits:
Provide families with concise, accurate information about ways to promote and develop good health habits in children; information should be presented in English and the families’ home languages. Capture their interest by addressing topics related to their children’s age and development, as well as topics related to common health risks for children, such as childhood obesity, asthma, and dental caries. Injury prevention and first-aid topics, such as treating burns, bleeding, and choking, are also relevant. Provide written informational materials that are brief and easy to read.
Provide individualized information, as well as general health information, to all families through daily contact, workshops, and parent meetings. All information should be presented in English and in the families’ home languages. Accommodate family schedules by providing workshops and meetings at various times (e.g., morning, afternoon, and evening), and arrange for child care during meetings.
Show family members what the children are learning by sending home examples of work, encouraging families to visit the preschool and observe children in action, and sharing children’s portfolios during home visits. Reinforce children’s learning about health habits through take-home activities, lending libraries of read-aloud books in the languages of the families in the group, and displays of children’s work.
As you introduce health routines (e.g., handwashing, tooth brushing), invite family members to participate and model. Encourage families to contribute ideas or materials to interest areas that reflect diverse health habits at home.
Identify community resources related to health habits (e.g., handwashing, tooth brushing) and invite community personnel to participate in and bring resources to family workshops or parent meetings. Emphasize the role of home and family members in helping children to develop health habits, and inform all parents of the availability of free and low-cost community resources.
Be sensitive to and respectful of different values or beliefs, as well as varying levels of access to health products and services. Gather information on available and accessible resources in the community, including those for children with special needs, and provide this information to all families, translated into their home languages.
References
This page was adapted from 7: Promoting Good Health and Wellness by Paris. in Paris, J. (2021). Health, safety and nutrition. LibreTexts.
For references according to subscript, please see pages 165-190 and 207-213 of the original Health, Safety and Nutrition book (Paris, 2021) on Google Drive.
Council for Professional Recognition. (3rd eds). (2023). Essentials for working with young children. First Printing.
Ferber, R. (2006). Solve your child's sleep problems. Touchstone.
Jenni, O. G., & O'Connor, B. B. (2005). Children's sleep: an interplay between culture and biology. Pediatrics, 115(1 Suppl), 204–216. https://doi.org/10.1542/peds.2004-0815B
